Let the People Say AMEN!

Dr. Marvella Ford in the hallway at MUSC.
Dr. Marvella Ford is an expert in cancer health disparities and leads Hollings' outreach efforts to minority and underserved populations across South Carolina.
"We have to really be explicit about educating black men about prostate cancer. There are a lot of myths about prostate cancer in the community. And so we want to really provide an incentive for men to participate and let them know how important they are to us, to their families and to their communities and to the state as a whole."
— Dr. Marvella Ford


MUSC Hollings Cancer Center Cancer Chat graphic

Episode Details

April 2021

Run Time: 30:56

Topics: health disparities, prostate cancer, cancer in Black men, community outreach, AMEN Program

Cancer health disparities are a major problem affecting minority and rural populations across South Carolina. Through innovative outreach efforts like the SC AMEN Program, MUSC Hollings Cancer Center is addressing this issue and helping people take ownership of the health of their communities.

Dr. Marvella Ford (00:00): We have to really be explicit about educating black men about prostate cancer. There are a lot of myths about prostate cancer in the community. And so we want to really provide an incentive for men to participate and let them know how important they are to us, to their families and to their communities and to the state as a whole. And that we are invested in their good health outcomes.

Narration (00:28): Welcome to Cancer Chat by MUSC Hollings Cancer Center. Today, Hollings Cancer Center director, Dr. Ray DuBois, talks cancer disparities, the AMEN project and prostate cancer research with Hollings associate director for population science and cancer disparities Dr. Marvella Ford. Enjoy the chat.

Dr. Raymond N. DuBois (00:48): This is Dr. Ray DuBois. I'm the director of the Hollings Cancer Center here at MUSC as well as the dean of the College of Medicine. I'm so delighted today that we're able to talk to Dr. Marvella Ford who's the associate director at Hollings for population science and cancer disparities. Marvella has just done an outstanding job of reaching out to our community partners and looking at health disparities related to cancer in the communities in South Carolina. And today she's going to tell us a little bit about what she's been doing. So Marvella, I've heard a lot about the AMEN project and what we want to know is why you're so excited about it.

Dr. Marvella Ford (01:30): Yes. Thank you so much, Dr. DuBois, I am really excited about the AMEN project because it really highlights an area that's often overlooked, and that is cancer in black men. Several years ago, South Carolina developed a state cancer plan, and that was done with involvement of the Medical University of South Carolina Hollings Cancer Center, as well as the University of South Carolina and the South Carolina Cancer Alliance and the state health department. And that report clearly showed that when you look at cancer rates in South Carolina, the mortality rates, or death rates, are driven by the rates among black men. And so back in 2019, I was approached by the South Carolina Cancer Alliance with an idea for a disparities focused volume. And I asked whether the South Carolina Cancer Alliance would be interested in doing a report on the cancer related health of black men in South Carolina.

Dr. Marvella Ford (02:32): And of course that generated a lot of excitement and we published the first report on cancer in black men in South Carolina. And that report had some really startling data that was very eye opening and it really gave us a good direction for interventions that we needed to implement, to reduce the disparities among black men. And so what we saw is that first of all, black men have the highest cancer death rates of any other group racial or ethnic group or gender group in South Carolina. And so it clearly showed us that if we are really serious about reducing disparities in South Carolina and reducing cancer mortality rates in South Carolina, we have to focus on cancer in black men. And so we looked at diseases such as prostate cancer and saw that the mortality rates for prostate cancer are three times higher among black men in South Carolina than among white men in South Carolina. So that told us that we have a lot of work to do.

Dr. Raymond N. DuBois (03:39): Yeah. That's I mean, I think you're, you're right on target there. What do you think the main aims of your program are after everything's said and done?

Dr. Marvella Ford (03:50): So what we're aiming to do is really to provide education about prostate cancer. We are providing navigation to prostate cancer screening, and we're also really working with our community partners to do follow-up care so that we can make sure that when men get screened, if they have abnormal results, they can get the care that they need. And what we've seen, we've done a cancer education training program in the community since 2007, and that's something called train the trainer, where we've gone out into communities. We've reached hundreds of people and they have reached thousands of people in turn taking the cancer education messages out to other people. But what we've learned is that first of all, more women than men participate in those training sessions. And it's really great that the women tell us that they're taking the information to the men in their lives, but it's very exciting to have a project that is specifically focused on black men. What we have learned from the train the trainer program is that we have to really be explicit about educating black men about prostate cancer. There are a lot of myths about prostate cancer in the community. And so we want to really provide an incentive for men to participate and let them know how important they are to us, to their families and to their communities and to the state as a whole. And that we are invested in their good health outcomes.

Dr. Raymond N. DuBois (05:30): Yeah, that's so important to gain the trust of the community and also to really try to understand what those precise barriers are because that's what's causing the problem. Marvella I understand that TD Bank has played a very important role. It's not typical for banks to do this. So maybe you could tell us how they got involved and why community partnerships are so important for this research to be successful.

Dr. Marvella Ford (05:56): Well, we were really with TD Bank because they saw a need. And what they saw in our state is that black men are dying of prostate cancer at three times the rate of white men in our state. And so TD Bank really approached us with a request for a project that focused on cancer disparities and especially disparities in black men. And so we're impressed that they saw the data and they saw the need. And so they allowed us to craft a project that would really help to meet that specific need. And we talked earlier about the intersectionality of race and gender. And so one example of that is the fact that a black man with a four-year college degree on average earns the same level of income as a white man with a high school diploma. And so that's one of the factors that affects black men. Black men tend to get paid much less than white men. The jobs that are available to black men are not the same as the jobs that are available to white men. And so black men have a lot of pressures and a lot of stresses in society. What we want to do consistently is to let black men know that their lives matter to us and that they are important to their families, their communities, to the state and to the Hollings Cancer Center.

Dr. Raymond N. DuBois (07:28): Yeah, I think that is a very important point to make. And, you know, there's a lot more out there these days about racial inequities and how that's affected our culture and how we think about things. And hopefully those will change as we move forward, but this work is very meaningful because you're addressing some of the core problems with that population. You know, I was really excited to see today that one of Biden's directives, the new administration, is to provide more support for historically black colleges and universities. So hopefully we will be able to also take advantage of that opportunity. The other part of this is that, you know, we are an NCI designated cancer center here at Hollings, and that really gives us this important mission in the state to really reach out and help do what we can for health disparities across our whole catchment area.

Dr. Raymond N. DuBois (08:24): And the other aspect of that is, as you know, Marvella, we want to achieve the comprehensive status. And part of that is reaching out to our community and really having an impact on the cancer outcomes of these disparate populations. So this is so critical, not only for doing what's right for the people of South Carolina, but also helping us to achieve our comprehensive status. So I guess one question and you've touched on it, but why are these minority men such a hard group to reach? Is it a trust issue? What is it that you think is the biggest barrier there?

Dr. Marvella Ford (09:05): That is a really good question. I think when we talk about intersectionality, where we are looking at the intersectionality of race and gender. And so if we start with gender and talk about male health, we know that there are a lot of barriers to male health in general. Some men see it as a weakness to admit that they're not feeling well. I mean, I think that's one of the reasons we still have people dying every year from pneumonia. A lot of those are men who try to take care of themselves at home and didn't want to admit how badly they felt and didn't want to, they feel like they're being a burden to the healthcare system if they go. And so I think it's working with gender issues or just around male health and helping men to feel comfortable about talking about their health, you know, giving them a forum and letting them know that it's okay to talk about health.

Dr. Marvella Ford (10:04): It's not a weakness, it's a strength. And you asked about mistrust and yes, absolutely. We have seen over and over a lot of instances where black men in particular have not been treated very well by the healthcare system. So, you know, their lack of trust is grounded in historical events. And one of those events is the Tuskegee syphilis study. And one of the things that I like to share when we go out to the community, I like to tell the story of something that happened to me back in 1996. I was invited to go to speak during the first ethics conference at what was then Tuskegee Institute. And that was a three-day conference. And it was sponsored by the National Cancer Institute and other organizations. At the time I had my first multi-million dollar grant from the National Cancer Institute and the CDC, and it was focused on recruiting African-American men to the prostate, lung, colorectal, and ovarian cancer screening trial, testing different methods, different strategies for recruiting black men.

Dr. Marvella Ford (11:16): And at the conference, we had participants including several of the survivors of the Tuskegee syphilis study and their attorney, Mr. Fred Gray. And it was amazing. And so we talked to them, they were very cordial, but on the third day of the conference, Mr. Gray stood up and he said, the men, he called the participants, the men, you know, he said, the men asked me to speak on their behalf. And he said, first of all, they wanted me to tell you that they are appalled because we have been sitting here for three days, hearing speaker after speaker, talk about how we do not have enough people of color in clinical trials. And he said, they're appalled. They didn't know that was happening. He said, the second thing the men wanted him to say is that they're proud of the fact that because they went through the atrocities of the Tuskegee study, we now have safeguards in place for clinical trial participants, such as the informed consent process, consent documents. We have data and safety monitoring committees, and we have institutional review boards that are required to include community members on their boards. And Mr. Gray said, the men are really proud that all these future generations of people now have all these safeguards in place. And the third thing he said is the men wanted me to tell you, if people of color don't participate in trials, it does a disservice to the men in the Tuskegee study because they feel like it makes what they went through in vain.

Dr. Raymond N. DuBois (12:58): That's really very, very inspirational Marvella. So one of the things that you have done very successfully here in South Carolina is to build these ties with the community. You've built this in a number of different ways and you have this program that you've called a MOVENUP program. How does that affect your interactions and making this research more successful?

Dr. Marvella Ford (13:26): So the MOVENUP program allows us to go into communities as partners. There's no hierarchy. We go to churches, we go to Jack and Joe, we go to sorority gatherings. We go in as equal partners. When we go in, we help move the furniture around to get it ready for the session. We wipe the tables down. At the end of the meeting, we move the furniture back the way it was, we're just there as community members. And it really allows us to get away from an academic center and go out into the community setting and to deliver information. And, you know, I use the example of moving furniture because when we go in, we don't go in with a high and mighty attitude. We go in saying, we know we have a shared mission. We're all here for the same purpose.

Dr. Marvella Ford (14:15): Let's do what needs to be done to get the room ready, or get things set up so that we can reach the people that we're all trying to reach. And little things like that really helped to establish trust and to build partnerships. And so what happens after doing that a few times, we've been doing this since 2007, even after the initial few times, the word got out. And so people will then refer other people to us, other organizations. And then when we write a grant, if there's a certain community partner, we can email them or we can call them. And there's already a level of trust that's established.

Dr. Raymond N. DuBois (14:54): That's so important because unless you are out there and sorta perceived as a part of the community in some way, it's hard to, for people to, to talk to you truthfully and let you know really what some of these issues are. So what is your overall hope with what the MOVENUP program will achieve in addition to really becoming better known in those communities? And, how do you think it will inform your future outreach strategies?

Dr. Marvella Ford (15:25): There are lots of groups around the state working hard on these issues, but one of the things that we do is look at the metrics of success. And since we started all of these statewide community outreach and engagement activities with other partners, other health systems, other community organizations, the death rates have decreased over time. They just haven't decreased as much for black men as for other groups, but we can see that we are making a difference.

Narration (15:51): Coming up next on Cancer Chat, Dr. Marvella Ford speaks about community outreach in rural South Carolina, risk factors for cancer in black men, and the impact a healthy diet has on cancer.

Dr. Marvella Ford (16:04): Obesity is a major risk factor for prostate cancer. Prostate cancer is a hormone-related cancer. Obesity is closely tied to prostate cancer risk.

Narration (16:14): Now back to Cancer Chat with doctors Ford and DuBois.

Dr. Raymond N. DuBois (16:19): What factors specifically, do you think contribute to the higher rate of prostate cancer mortality? Is it simply the screening or the fear of, you know, coming into a complicated medical center to get treatment? What do you think is playing the biggest role there?

Dr. Marvella Ford (16:36): Because we're the only NCI designated cancer center in South Carolina, that's really allowed us to go out into a lot of the rural areas of the state. And that's been very eye opening for me because it helped me to understand that if you live in Bamberg, South Carolina or Barnwell, and you have to go to Charleston for your treatment, the distance isn't great, the cultures are worlds apart. And so coming to a city of you know, 750,000 people in the Metro Charleston area from a very rural area could be very overwhelming. We're asking people to leave, maybe their primary care physicians, maybe they've had for 20 years, and the rural area to go to the big city, to meet with a series of doctors they've never met before. And it can be very overwhelming, just the drive itself, navigating streets and the strange city, even getting from the parking garage, the parking structure to the clinic, which may seem small, but when people are stressed and anxious, that can be very overwhelming. And that's why we built navigation into the AMEN Project, because we want to make sure that we are helping them get to the screening sites and helping them navigate the distance both geographically and culturally and emotionally and socially.

Dr. Raymond N. DuBois (18:04): Yeah, I think that's so important. I know that the traffic can be bad. It's sometimes raining and flooding and, you know, there's all kinds of barriers to getting into the medical center sometimes. For our listeners, maybe you could just delineate who you think is eligible for prostate cancer screening and what factors really contribute most to that risk for prostate cancer.

Dr. Marvella Ford (18:27): The three greatest risk factors for prostate cancer are age, race, and family history. So the older the men are, the higher their risk. Black men just being black, by itself, puts you at greater risk of developing prostate cancer and then having a family history. So we want to, since our project focuses on African-American or black men, we really want to focus on men who are aged 40 and over. The reason is prostate cancer tends to be diagnosed earlier in black men than in other men. And we want to make sure that we can help men to get screened so that their cancer can be detected at as early a stage as possible so that the survival outcomes and benefits are the best they can be.

Dr. Raymond N. DuBois (19:19): Yeah. That makes sense. Are there any ways that you can tell the listeners for how men can reduce their risk for prostate cancer?

Dr. Marvella Ford (19:28): Yes. So we talk a lot when we go out into the community about ways to reduce cancer risk, and, you know, we are still looking, I mean, there are a lot of scientists who are still looking for specific factors, but we certainly know that obesity is a major risk factor for prostate cancer. Prostate cancers is a hormone-related cancer. Obesity is closely tied to prostate cancer risk. There's a difference between eating a baked potato, which looks the way it looked when it came out of the earth versus a potato chip. So you know, staying away from processed foods, we talk a lot about preservatives in the foods. So I use the example of if I gave you a cake and you put it in your pantry for three months, and then I came to your house three months later, and you went to your pantry and said, Oh, let's have some of that cake you gave me three months ago. Would we be able to eat it? No absolutely not. We have to ask ourselves what is in these foods that's keeping them so long. And is that really what we want to put into our bodies?

Dr. Raymond N. DuBois (20:31): That's very instructive there because they're obviously preserved somehow with something chemical or something that makes them a lot longer lasting. Well, let's say I was going to be recruited into the AMEN project. How would it look through the eyes of a participant? What steps are involved? How would you engage with me as a potential participant of the project?

Dr. Marvella Ford (20:57): So we're working with a lot of community organizations to help us identify participants for the AMEN project. And we, because we're working with men, we really had to up the ante and we know that it takes a lot for men to come out to an educational session or even participate in a virtual session. And so we have a lot of giveaways, we're going to give away the equivalent of an iPad at every session. We thought that would catch the attention of some of the men. So yes, and we're also giving them a gift card for participating, $60 gift cards for each session in recognition of their time spent in the program. And that's really to let them know how valuable they are to us. And then we'll stay in contact with them, we'll follow them for a year after they participate in the initial one hour educational session, we'll refer them to screening.

Dr. Marvella Ford (21:56): We'll navigate them to make sure that they actually received the screening. And if their screening results were abnormal, then we'll follow up with them to make sure that they get follow up. We're referring them to federally qualified health centers that are close to where they live. Those are centers that will provide care for them. And also the physicians at the federally qualified health centers will also provide follow-up care for the participants. We're going to follow them for a year and administer surveys and ask them about what their thoughts are about prostate cancer, whether they intend to get prostate cancer screening and how satisfied they are with their decision to get screened.

Dr. Raymond N. DuBois (22:38): So you mentioned the federally qualified health centers. I think that sounds like a very important component of the project. So why is it important to link them to those centers that are closest to where they live?

Dr. Marvella Ford (22:52): That's a great question because South Carolina is very rural. So 75% of the counties in South Carolina have areas that are designated by HRSA as being rural. And so transportation is often an issue. We talked a little bit earlier about people not feeling comfortable if they're from very rural areas, maybe feeling a little bit of discomfort, going to a more urban area. And so we want to make sure that the men know that there are great screening resources available to them in their own communities. They don't have to leave their communities to get screened. They can stay where they feel comfortable and they can get screened and get the care that they need. And we will work with them. We'll help them, we'll give them the information about where to go to get screened and we'll follow up with them to make sure that they actually went.

Dr. Raymond N. DuBois (23:46): Wonderful. And what role does word of mouth or the use of ambassadors play in a project like this one? That's so complicated.

Dr. Marvella Ford (23:53): I think it goes back to the issue of trust that you talked about. So if we went to all these rural areas on our own and set up a shop and opened up a storefront and said, we're here to help. It wouldn't go very far, but by partnering with groups that are in the community already, and that are trusted, it makes it easier. So I think the reason we've been successful in the MOVENUP cancer education train the trainer program is that we at MUSC don't do any recruiting. We partner with community partners who recruit people in their networks to come to the sessions and we'll do the same with the AMEN project so that they will actually recruit participants to the sessions.

Dr. Raymond N. DuBois (24:43): Marvella, you know we've talked about your work before, and today you had a session with some sort of board members that have been reviewing your work, and you seem very, very passionate about this. So what makes you so passionate about this kind of work and outreach?

Dr. Marvella Ford (25:02): That I think is it comes from my personal background. So when I was born, all four of my grandparents had already died by the time I was born. And so I think as a child, just growing up and not having any grandparents, I just felt that as a tremendous loss and I've realized now I can put it into a larger context that life expectancy is shorter in black people. But it really drives the work. And my entire career, the focus is really to help family members enjoy each other for as long as possible because so many black people are dying prematurely when they could have lived another 10, 15, 20 years, that would have been long enough to see their grandchildren, see their grandchildren graduate from elementary school, high school, college, get married and maybe see their great grandchildren.

Dr. Raymond N. DuBois (26:01): Marvella, you know, one thing I wanted to let you know is, you recently gave a presentation to the new Stand Up to Cancer colon cancer screening effort. And this was a national symposium of the top researchers around the country from all the top schools. And I just wanted to tell you that they could tell from your presentation that you're so dedicated to this, you're so involved in getting connected to these communities, they were very impressed. And, you know, I haven't told you this personally, but they thought that this is what it's going to take to really break through these barriers, because unless there's this trust factor, I don't think people are going to be willing to get the prostate screening, the colon screening, breast screening, any of that screening done that's so needed to break down these disparities and improve the outcomes. So I'm just taking advantage of this podcast to give you some feedback there. So where do you think more work is needed on this research? Especially in young African-American men who seem to be the most resistant part of the population.

Dr. Marvella Ford (27:15): I think it's just thinking outside of the box, because if we try to keep using the same strategies, we'll get the same results. And so if we want different results, we have to use different strategies. And so really we want to work with different populations and let the men know that we really care. And I think there's something called practicing the ministry of presence, which is just showing up basically, and just being there. And a lot of what we do, the secret to a lot of it is just showing up, it's showing up for community events. So when community members invite us to participate in events, we're there, if they invite us to speak to their group, we're there, we give the same quality and the same level of interaction, whether we're speaking to two people, 200 people, or 2000 people, they will always get the same quality of product from us. And I think when they see that, that really makes a difference because they know that we're not just, we see them as people. And I think a lot of community outreach and engagement is about seeing each other and hearing each other and really communicating.

Dr. Raymond N. DuBois (28:33): Yeah. And I think the caring part of it is really important. So I have one last question for you. Marvella, how does the AMEN project tie into the other programs at Hollings that we offer to the community on outreach and engagement? And it sounds like it's a piece of a larger puzzle that you're putting together to really have an effective outreach to our whole catchment area, all citizens of the state. So how does AMEN tie into that?

Dr. Marvella Ford (29:04): Yes. So AMEN ties into a lot of the work that we're doing. So we're focusing on black men and the AMEN project. We also have a human papillomavirus vaccine focus at the Hollings Cancer Center. And we thank you for your support. We currently have a statewide project that focuses on social media strategies, educating school nurses. And that project is led by Dr. Kathleen Cartmell. We also have a strong focus in tobacco cessation. And so Dr. Michael Cummings and others are leading our efforts with other community partners, other organizational partners in the state to really roll out smoking evaluation and cessation treatments in hospitals around the state that we hope will reach a large number of patients and community members.

Dr. Raymond N. DuBois (29:58): Yeah, I'm so excited about all of that work. I think it's very meaningful and it's going to really be a positive impact on the cancer center. Well, today I've been speaking with Dr. Marvella Ford, who is the associate director for population science and cancer disparities here at the Hollings Cancer Center in Charleston, South Carolina. Marvella, you're just inspirational to me by all the work that you're doing. And even one life saved, I think is so important. And you're going to save a lot more than that through your work. Any closing thoughts before we sign off?

Dr. Marvella Ford (30:35): No, just thank you so much for your time today and allowing us to speak. And we thank the people of South Carolina for working with us. We're all in this together.


Episode Guests

Profile Raymond DuBois, M.D. 

Raymond N. DuBois, M.D., Ph.D.

Director, Hollings Cancer Center

Dr. Marvella Ford 

Marvella Ford, Ph.D.

Associate Director, Population Science and Cancer Disparities

cancer in african american men in South Carolina report cover showing a middle aged man and a teenage boy

Special Report

The report addresses the many cancer-related challenges facing African American men in the state.

Read the report